Healthcare Provider Details

I. General information

NPI: 1659513166
Provider Name (Legal Business Name): ENRIQUE MOLINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ENRIQUE GERARDO MOLINA M.D.

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SHERIDAN ST STE F
HOLLYWOOD FL
33021-3420
US

IV. Provider business mailing address

4700 SHERIDAN ST STE M
HOLLYWOOD FL
33021-3420
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-4800
  • Fax: 954-961-8401
Mailing address:
  • Phone: 954-961-8400
  • Fax: 954-961-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME102292
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME102292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: